Yesterday, in responding to Kevin Kilroy’s WorkCompWire article, I lauded SCIF for its very fine record when it comes to electronic claims processing. By way of contrast to SCIF, below is a graph for a claims administrator with a very different record. Among its other problems, this claims administrator consistently fails to return error-free electronic explanations of reviews as mandated by the DWC e-billing guidelines.

And here’s SCIF’s graphs again:

As a reminder, in 2012, California’s DWC adopted specific guidelines regarding claims administrators’ duties to respond to treatment bills. These guidelines include mandated adoption of EDI technology, information requirements of the explanation of review (EOR) and processing timelines. The chart above reflects an, at best, inconsistent level of adherence to these guidelines.

Because I strongly believe in making things easy for both our customers and claims administrators, this is a timeline--specific to each bill--that accompanies every bill sent by DaisyBill and which outlines the claims administrator’s responsibilities.

All this, of course, brings me to my main comment on Kilroy’s article. Although I agree that our industry should not blindly adopt technology and its presumed efficiencies, it is precisely because of technology that DaisyBill has been able to track SCIF’s record for processing bills. We have data for all claims administrators and have automated graphing to show their e-billing history and adherence to the DWC’s rules and regulations.

I think it’s worthwhile to put some of our data out there. I’m going to start a series of posts that show graphs for different claims administrators, charting their adherence to different regulatory requirements for workers’ compensation billing.

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